BEHAVIOURAL OBSERVATION AUDIOMETRY
(BOA)

No baby is too young to be tested. Modern technology has provided us the tools with which to reliably measure hearing in newborns.

If you suspect hearing difficulty in your newborn, or s/he has got a ‘Refer’ on the rescreening of the newborn hearing screening test, you are going to be looking for diagnostic information on your baby’s hearing levels. Your newborn’s sucking response as she breastfeeds or bottle feeds, is the most reliable response that s/he can provide at this stage of development. This method of testing hearing in newborns (from birth to six months of age), by observing their sucking response to sound (i.e.tones) or speech is called Behavioural Observation Audiometry (BOA).

The audiologist will give you an appointment for BOA to test your infant’s hearing, after talking to you about his or her feeding schedule. The audiologist will explain that your infant needs to be feeding and in light sleep throughout the testing procedure. A start or cessation in sucking response as observed, in response to a sound or speech stimulus will be taken as a response.

BOA measures your baby’s responses to sound across the speech frequency range of 250 Hz.(Hertz) upto 8000 Hz. (Hertz). The audiologist may choose Narrow Band Noise (NBN) or Warble Tones as the sound stimulus, as these are tones that interest your newborn at this age. Each ear is tested individually, at each of these frequencies, to obtain ear specific and frequency specific information, that is reliable. Ear inserts or insert earphones are used to deliver the sound stimulus reliably to your baby’s ears, in order to obtain individual ear information.

The audiologist will encourage you to assume the same position during testing that you do when feeding your infant at home. You will be guided to stay still throughout the testing, so as not to alert your infant to the onset of the stimulus in any way. You and your infant will be allowed breaks to adjust position and re gain your levels of comfort.

Testing using BOA takes time and is done over several sessions.

The responses that your baby gives to both sounds (i.e.tones) and speech over the frequency range, in each ear, will then be plotted on an audiogram or graph to obtain your infant’s unaided audiogram. Your infant’s unaided audiogram is a measue of his or her hearing loss. The audiogram will help you understand whether your infant has the access his or her brain needs to understand spoken language and to learn like other babies the same age. These responses will help determine

  1. presence of hearing loss if any
  2. which model of hearing aid best supports your infant’s hearing loss
  3. the settings for your infant’s hearing aids
  4. whether your infant needs a cochlear implant

Once your infant has been fitted with hearing aids in both ears and is wearing them during all his or her waking hours for approximately three to four weeks, the audiologist will measure your infant’s responses to sound (i.e. tones) and speech, with hearing aids, one ear at a time, using BOA.The audiologiat will then plot these responses, to obtain your infant’s aided audiogram.

Behavioural Observation Audiometry (BOA) provides a reliable method to measure, manage and monitor your infant’s hearing loss during the first six months of life.

Other Tests That Can be Relevant to Your Case

Visual Reinforcement Audiometry (VRA)

VRA is the method of testing hearing in babies and young children between the ages of six months and thirty-six months, observing the child's head turn towards a visual reinforcer such as a toy that lights up.

Conditioned Play Audiometry (CPA)

CPA is the method of testing hearing in children who have a cognitive age of atleast 30 months, in which they are expected to do the listen and drop task.

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